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New FBI Report: One Arrest for Drug Possession Every 25 Seconds in 2016, As Drug War Rages On

Wed, 09/27/2017 - 07:00
Click here for reuse options! Criminalizing drug use hurts families and communities.

You may have heard that President Trump and Attorney General Jeff Sessions are “re-starting” the drug war.  Well, it never actually ended.

According to the FBI’s new Uniform Crime Report, law enforcement agencies in the U.S. made more than 1.57 million arrests for drug law violations in 2016, a 5.63% increase over the previous year – and over three times more arrests than for all violent crimes combined.

More than four out of five of those arrests – 84.6%, or 1,330,401 arrests – were simply for drug possession.  Marijuana arrests also increased – about 41% of all drug arrests were for marijuana, the vast majority for simple possession.

These massive numbers are way out of sync with national public opinion, as a majority of Americans now support not just legalizing marijuana, but also ending criminal punishment for drug use.  As detailed in a recent Drug Policy Alliance report, there’s an emerging political and scientific consensus that otherwise-law-abiding people should not be arrested, let alone locked away behind bars, simply for using or possessing a drug.

Discriminatory enforcement of drug possession laws has produced profound racial and ethnic disparities at all levels of the criminal justice system. Black people comprise just 13% of the U.S. population and use drugs at similar rates as other groups – but they comprise 29% of those arrested for drug law violations and 35% of those incarcerated in state prison for drug possession.

Drug criminalization also fuels mass detentions and deportations.  For noncitizens, including legal permanent residents – many of whom have been in the U.S. for decades and have jobs and families – possession of any amount of any drug (except first-time possession of less than 30 grams of marijuana) can trigger automatic detention and deportation, often without the possibility of return.

Several countries have successful experience with ending criminal penalties for drug use and possession, most notably Portugal.  In 2001, Portugal enacted one of the most extensive drug law reforms in the world when it decriminalized low-level possession and use of all illegal drugs.

Today in Portugal, no one is arrested or incarcerated for drug possession, many more people are receiving treatment, and addiction, HIV/AIDS and drug overdose have drastically decreased.

Polls of U.S. presidential primary voters last year found that substantial majorities support ending arrests for drug use and possession in Maine (64%), New Hampshire (66%) and even South Carolina (59%).  In 2016, the first state-level decriminalization bill was introduced in Maryland and a similar version was reintroduced in 2017. The Hawaii legislature, meanwhile, overwhelmingly approved a bill last year creating a commission to study decriminalization.

Earlier this year, the United Nations and World Health Organization released a joint statement calling for repeal of laws that criminalize drug use and possession. They join an impressive group of national and international organizations who have endorsed drug decriminalization that includes the International Red Cross, Organization of American States, Movement for Black Lives, NAACP, and American Public Health Association, among many others.

The FBI’s new data lays bare how the drug war continues to be a major driver of not just mass incarceration, but mass criminalization more broadly.  Criminalizing drug use hurts families and communities, compounds social and economic inequalities, and unfairly denies millions of people the opportunity to support themselves and their families.

What we’re doing doesn’t work – and actually makes things worse. Our limited public resources would be better spent on expanding access to effective drug treatment and other health services. As overdose deaths skyrocket all over the U.S., people who need drug treatment or medical assistance may avoid it in order to hide their drug use.  If we decriminalize drugs, people can come out of the shadows and get help.

We now have a federal administration determined to ramp up the drug war – but most drug enforcement is carried out at the local and state levels, so jurisdictions across the U.S. are responding to Trump and Sessions by moving drug policy reforms forward with increasing urgency.  This week’s latest FBI report gives us more than a million reasons why these reforms are so crucial.

This piece first appeared on the Drug Policy Alliance Blog.

 

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New FBI Report: One Arrest for Drug Possession Every 25 Seconds in 2016, As Drug War Rages On

Wed, 09/27/2017 - 07:00
Click here for reuse options! Criminalizing drug use hurts families and communities.

You may have heard that President Trump and Attorney General Jeff Sessions are “re-starting” the drug war.  Well, it never actually ended.

According to the FBI’s new Uniform Crime Report, law enforcement agencies in the U.S. made more than 1.57 million arrests for drug law violations in 2016, a 5.63% increase over the previous year – and over three times more arrests than for all violent crimes combined.

More than four out of five of those arrests – 84.6%, or 1,330,401 arrests – were simply for drug possession.  Marijuana arrests also increased – about 41% of all drug arrests were for marijuana, the vast majority for simple possession.

These massive numbers are way out of sync with national public opinion, as a majority of Americans now support not just legalizing marijuana, but also ending criminal punishment for drug use.  As detailed in a recent Drug Policy Alliance report, there’s an emerging political and scientific consensus that otherwise-law-abiding people should not be arrested, let alone locked away behind bars, simply for using or possessing a drug.

Discriminatory enforcement of drug possession laws has produced profound racial and ethnic disparities at all levels of the criminal justice system. Black people comprise just 13% of the U.S. population and use drugs at similar rates as other groups – but they comprise 29% of those arrested for drug law violations and 35% of those incarcerated in state prison for drug possession.

Drug criminalization also fuels mass detentions and deportations.  For noncitizens, including legal permanent residents – many of whom have been in the U.S. for decades and have jobs and families – possession of any amount of any drug (except first-time possession of less than 30 grams of marijuana) can trigger automatic detention and deportation, often without the possibility of return.

Several countries have successful experience with ending criminal penalties for drug use and possession, most notably Portugal.  In 2001, Portugal enacted one of the most extensive drug law reforms in the world when it decriminalized low-level possession and use of all illegal drugs.

Today in Portugal, no one is arrested or incarcerated for drug possession, many more people are receiving treatment, and addiction, HIV/AIDS and drug overdose have drastically decreased.

Polls of U.S. presidential primary voters last year found that substantial majorities support ending arrests for drug use and possession in Maine (64%), New Hampshire (66%) and even South Carolina (59%).  In 2016, the first state-level decriminalization bill was introduced in Maryland and a similar version was reintroduced in 2017. The Hawaii legislature, meanwhile, overwhelmingly approved a bill last year creating a commission to study decriminalization.

Earlier this year, the United Nations and World Health Organization released a joint statement calling for repeal of laws that criminalize drug use and possession. They join an impressive group of national and international organizations who have endorsed drug decriminalization that includes the International Red Cross, Organization of American States, Movement for Black Lives, NAACP, and American Public Health Association, among many others.

The FBI’s new data lays bare how the drug war continues to be a major driver of not just mass incarceration, but mass criminalization more broadly.  Criminalizing drug use hurts families and communities, compounds social and economic inequalities, and unfairly denies millions of people the opportunity to support themselves and their families.

What we’re doing doesn’t work – and actually makes things worse. Our limited public resources would be better spent on expanding access to effective drug treatment and other health services. As overdose deaths skyrocket all over the U.S., people who need drug treatment or medical assistance may avoid it in order to hide their drug use.  If we decriminalize drugs, people can come out of the shadows and get help.

We now have a federal administration determined to ramp up the drug war – but most drug enforcement is carried out at the local and state levels, so jurisdictions across the U.S. are responding to Trump and Sessions by moving drug policy reforms forward with increasing urgency.  This week’s latest FBI report gives us more than a million reasons why these reforms are so crucial.

This piece first appeared on the Drug Policy Alliance Blog.

 

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The Dreaded Marijuana Cotton Mouth: How Dangerous Is It and What Can You Do About It?

Tue, 09/26/2017 - 10:16
It's called xerostomia and it's a serious issue for cannabis consumers.

Cotton mouth. It has become almost a punch line among marijuana enthusiasts. It’s not just folk lore and it’s not all in the mind, a collection of research has shown that dry mouth is more prevalent as cannabis use increases. It’s not a laughing matter for some users. Saliva plays an important role in our health and deserves more of our attention.

Saliva is created by our salivary glands, which are really a collection of four types of glands, that each secrete different substances through ducts distributed throughout the mouth. Together, the secretions make up the concoction of water, electrolytes and enzymes that function to keep our mouth healthy and help to begin the digestion process. When this process is interrupted, we can experience a dry mouth.

Spit. Taken for granted, we can forget that saliva protects and lubricates the mouth, helps us speak, eat, taste food and swallow. It also protects the throat, mouth and teeth from viruses, bacteria and other microorganisms. Without sufficient stores of saliva, we run a higher risk for tooth decay and cavities. It increases the risk of periodontal disease and even loss of teeth

 

Xerostomia is the proper name and it can be common for pot smokers as well as those taking cannabis concentrates in pill form as well.

This is not a side effect unique to marijuana. Over 1,800 medicines list dry mouth as a possible side effect. Fortunately, in most cases, regular saliva flow is typically restored once the medicine use is discontinued.

Patients with cancer who have experienced radiation treatments to the head, face or neck can lose function of salivary glands as well. In these cases, the condition can last months or longer.

What can a cannabis user do?

The American Dental Association suggests regular visits to your dentist as well as chewing sugar-free gum and brushing your teeth at least twice a day with a toothpaste containing fluoride. Other professionals also suggest reduction in citrus based food and drinks as well as alcohol based breath sprays, mouthwashes and beverages because they tend to further dry the mouth. Over the counter sprays and gums that aid in keeping the mouth moist are also available any most local drug stores.

For all the benefit moderate cannabis use can bring, don’t let dry mouth spoil things. A bit of knowledge, regular professional dentist visits and attention to the types of food and drink you select should help you mitigate the problem.

 

 Related Stories
Categories: News Feeds

The Dreaded Marijuana Cotton Mouth: How Dangerous Is It and What Can You Do About It?

Tue, 09/26/2017 - 10:16
It's called xerostomia and it's a serious issue for cannabis consumers.

Cotton mouth. It has become almost a punch line among marijuana enthusiasts. It’s not just folk lore and it’s not all in the mind, a collection of research has shown that dry mouth is more prevalent as cannabis use increases. It’s not a laughing matter for some users. Saliva plays an important role in our health and deserves more of our attention.

Saliva is created by our salivary glands, which are really a collection of four types of glands, that each secrete different substances through ducts distributed throughout the mouth. Together, the secretions make up the concoction of water, electrolytes and enzymes that function to keep our mouth healthy and help to begin the digestion process. When this process is interrupted, we can experience a dry mouth.

Spit. Taken for granted, we can forget that saliva protects and lubricates the mouth, helps us speak, eat, taste food and swallow. It also protects the throat, mouth and teeth from viruses, bacteria and other microorganisms. Without sufficient stores of saliva, we run a higher risk for tooth decay and cavities. It increases the risk of periodontal disease and even loss of teeth

 

Xerostomia is the proper name and it can be common for pot smokers as well as those taking cannabis concentrates in pill form as well.

This is not a side effect unique to marijuana. Over 1,800 medicines list dry mouth as a possible side effect. Fortunately, in most cases, regular saliva flow is typically restored once the medicine use is discontinued.

Patients with cancer who have experienced radiation treatments to the head, face or neck can lose function of salivary glands as well. In these cases, the condition can last months or longer.

What can a cannabis user do?

The American Dental Association suggests regular visits to your dentist as well as chewing sugar-free gum and brushing your teeth at least twice a day with a toothpaste containing fluoride. Other professionals also suggest reduction in citrus based food and drinks as well as alcohol based breath sprays, mouthwashes and beverages because they tend to further dry the mouth. Over the counter sprays and gums that aid in keeping the mouth moist are also available any most local drug stores.

For all the benefit moderate cannabis use can bring, don’t let dry mouth spoil things. A bit of knowledge, regular professional dentist visits and attention to the types of food and drink you select should help you mitigate the problem.

 

 Related Stories
Categories: News Feeds

The Opioid Epidemic is Intertwined With Rising Hep C Infections, Other Serious Illnesses

Tue, 09/26/2017 - 09:56
The country is experiencing a "syndemic" -- multiple diseases feeding off of one another, compounding community health burdens.

Many Americans now know that, over the past decade, opioid addiction and deaths from opioid overdose in the U.S. have skyrocketed.

But we don’t hear as often about the other epidemics intertwined with this public health crisis. In rural Scott County, Indiana, for example, prescription opioid injections have been linked to overlapping outbreaks of HIV and the hepatitis C virus.

This is a “syndemic”: multiple diseases feeding off of one another, compounding a community’s health burdens.

Syndemic theory – first introduced by medical anthropologist Merrill Singer more than a decade ago – explains how epidemics interact with one another. The interplay of these diseases increases the risk for a number of infections, like sexually transmitted infections and HIV.

There are many interrelated epidemics within the “opioid syndemic.” Together, they make up perhaps the biggest public health challenge in the U.S. since the advent of the AIDS epidemic.

What we need to know

Before we can tackle this challenge, we need to understand where the opioid syndemic is most intense.

In the U.S., we have many public health surveillance systems that assess changes across geography and time. For example, AIDSVu, an online interactive map, tracks HIV data across U.S. counties. In some regions, the data maps across ZIP codes and census tracts.

Systems such as these help us compare disease outcomes across different places and demographic groups. However, when it comes to the opioid syndemic, we need to do more to identify local hotspots. Hotspots are places where outbreaks cluster together in a statistically significant way, in adjacent neighborhoods or communities with elevated disease rates.

Scientists like myself have started using a range of geospatial and statistical approaches to improve our understanding of the opioid syndemic. These tools allow us to find patterns in data on related health issues. We can also determine which characteristics of an individual, community or social network – such as syringe sharing and unsafe sex – are associated with hotspots.

These analyses can help public health departments and clinicians target local responses where they are most needed, when they are most needed and with the local subpopulations that most need them.

Finding hotspots

In Massachusetts, where I am based, opioid overdose deaths quintupled over the past 15 years. The state Senate and Governor Charlie Baker have established a new legislative mandate to systematically assess the key factors associated with the opioid syndemic.

There are many health issues associated with opioid use, including HIV, hepatitis C, STIs, soft tissue infections, mental illness and neonatal abstinence syndrome, which is related to exposure to drugs in the womb. For example, hepatitis C infections nationwide have nearly tripled since 2010.

Working alongside local and state public health departments, academic institutions and community-based agencies, we study the distribution of these health issues across Massachusetts and beyond. Our “risk maps” help us better understand the geographic distribution of opioid syndemic illnesses over time.

We measure risks by the burden of disease (e.g., the number of fatal overdoses) and rates (e.g., the number of hepatitis C infections per 100,000 people) across local communities. We also measure and map risk behaviors – such as syringe sharing, unsafe sex and doctor shopping – through surveys with health care professionals and people in the throes of addiction.

We have identified a number of hotspots tied to the opioid syndemic. For example, some hotspots for prescription opioids appear to overlap with drug overdoses.

We’ve identified cities and towns with significant clusters of hepatitis C and HIV. Springfield, Boston, Fall River, New Bedford and parts of Cape Cod, for instance, have notable overlapping hotspots for opioid overdose deaths, hepatitis C and HIV.

Among youth and young adults, we’ve also noted an increase in infectious endocarditis, an infection of the heart valve often caused by reuse and sharing of contaminated syringes.

How hotspot mapping can help

Mapping the opioid syndemic and related hotspots, we can better inform public health policy decisions, as well as clinical decisions for health care workers.

Such analyses can help to pinpoint the locations, communities and specific behaviors that could most benefit from interventions. For example, peer navigators who have “been there and done that” could visit overlapping hotspots and make it easier for high-risk populations to access sterile syringes, condoms, hepatitis C treatment and naloxone, the overdose reversal drug.

Additional programs could focus on educating medical providers, pharmacists and patients in hotspots, to improve opioid prescribing practices and increase disease testing rates.

Released inmates have some of the highest risks for opioid overdose. Corrections facilities could try to improve their transitions back into local hotspot communities, by facilitating direct referrals to drug treatment programs and job training programs.

Of course, it will take continued collaboration and enhanced funding from governments and foundations to see these efforts forward. But there is no better time than the present to address one of our nation’s largest health crises.

 

 Related Stories
Categories: News Feeds

The Opioid Epidemic is Intertwined With Rising Hep C Infections, Other Serious Illnesses

Tue, 09/26/2017 - 09:56
The country is experiencing a "syndemic" -- multiple diseases feeding off of one another, compounding community health burdens.

Many Americans now know that, over the past decade, opioid addiction and deaths from opioid overdose in the U.S. have skyrocketed.

But we don’t hear as often about the other epidemics intertwined with this public health crisis. In rural Scott County, Indiana, for example, prescription opioid injections have been linked to overlapping outbreaks of HIV and the hepatitis C virus.

This is a “syndemic”: multiple diseases feeding off of one another, compounding a community’s health burdens.

Syndemic theory – first introduced by medical anthropologist Merrill Singer more than a decade ago – explains how epidemics interact with one another. The interplay of these diseases increases the risk for a number of infections, like sexually transmitted infections and HIV.

There are many interrelated epidemics within the “opioid syndemic.” Together, they make up perhaps the biggest public health challenge in the U.S. since the advent of the AIDS epidemic.

What we need to know

Before we can tackle this challenge, we need to understand where the opioid syndemic is most intense.

In the U.S., we have many public health surveillance systems that assess changes across geography and time. For example, AIDSVu, an online interactive map, tracks HIV data across U.S. counties. In some regions, the data maps across ZIP codes and census tracts.

Systems such as these help us compare disease outcomes across different places and demographic groups. However, when it comes to the opioid syndemic, we need to do more to identify local hotspots. Hotspots are places where outbreaks cluster together in a statistically significant way, in adjacent neighborhoods or communities with elevated disease rates.

Scientists like myself have started using a range of geospatial and statistical approaches to improve our understanding of the opioid syndemic. These tools allow us to find patterns in data on related health issues. We can also determine which characteristics of an individual, community or social network – such as syringe sharing and unsafe sex – are associated with hotspots.

These analyses can help public health departments and clinicians target local responses where they are most needed, when they are most needed and with the local subpopulations that most need them.

Finding hotspots

In Massachusetts, where I am based, opioid overdose deaths quintupled over the past 15 years. The state Senate and Governor Charlie Baker have established a new legislative mandate to systematically assess the key factors associated with the opioid syndemic.

There are many health issues associated with opioid use, including HIV, hepatitis C, STIs, soft tissue infections, mental illness and neonatal abstinence syndrome, which is related to exposure to drugs in the womb. For example, hepatitis C infections nationwide have nearly tripled since 2010.

Working alongside local and state public health departments, academic institutions and community-based agencies, we study the distribution of these health issues across Massachusetts and beyond. Our “risk maps” help us better understand the geographic distribution of opioid syndemic illnesses over time.

We measure risks by the burden of disease (e.g., the number of fatal overdoses) and rates (e.g., the number of hepatitis C infections per 100,000 people) across local communities. We also measure and map risk behaviors – such as syringe sharing, unsafe sex and doctor shopping – through surveys with health care professionals and people in the throes of addiction.

We have identified a number of hotspots tied to the opioid syndemic. For example, some hotspots for prescription opioids appear to overlap with drug overdoses.

We’ve identified cities and towns with significant clusters of hepatitis C and HIV. Springfield, Boston, Fall River, New Bedford and parts of Cape Cod, for instance, have notable overlapping hotspots for opioid overdose deaths, hepatitis C and HIV.

Among youth and young adults, we’ve also noted an increase in infectious endocarditis, an infection of the heart valve often caused by reuse and sharing of contaminated syringes.

How hotspot mapping can help

Mapping the opioid syndemic and related hotspots, we can better inform public health policy decisions, as well as clinical decisions for health care workers.

Such analyses can help to pinpoint the locations, communities and specific behaviors that could most benefit from interventions. For example, peer navigators who have “been there and done that” could visit overlapping hotspots and make it easier for high-risk populations to access sterile syringes, condoms, hepatitis C treatment and naloxone, the overdose reversal drug.

Additional programs could focus on educating medical providers, pharmacists and patients in hotspots, to improve opioid prescribing practices and increase disease testing rates.

Released inmates have some of the highest risks for opioid overdose. Corrections facilities could try to improve their transitions back into local hotspot communities, by facilitating direct referrals to drug treatment programs and job training programs.

Of course, it will take continued collaboration and enhanced funding from governments and foundations to see these efforts forward. But there is no better time than the present to address one of our nation’s largest health crises.

 

 Related Stories
Categories: News Feeds

More Arrests for Marijuana Than for Violent Crime Last Year

Mon, 09/25/2017 - 14:23
Click here for reuse options! The mass arrests are at odds with public opinion that supports ending the drug war.

Despite spreading marijuana legalization and a growing desire for new directions in drug policy, the war on drugs continues unabated. According to the FBI's latest Uniform Crime Report, released Monday, overall drug arrests actually increased last year to 1.57 million, a jump of 5.63 percent over 2015. The increase includes marijuana arrests, which jumped by more than 75,000 last year compared to 2015, an increase of 12 percent.

That comes out to three drug arrests every minute, day in and day out, throughout 2016. It's also more than three times the number of people arrested for violent crimes. Drug offenses are the single largest category of crimes for which people were arrested last year, more than burglaries, DUIs or any other criminal offense. 

Unlike previous years, this year's Uniform Crime Report did not immediately make available data on specific offenses, such as drug possession or drug sales, nor did it break arrests down by type of drug, but the Marijuana Policy Project obtained marijuana arrest data by contacting the FBI. It reported some 653,000 people arrested on marijuana charges last year, although the FBI did not provide data on how many were simple possession charges. 

While that figure marks a decline from historic highs a decade ago—pot arrests peaked at nearly 800,000 in 2007—the sharp jump in pot arrests last year demands explanation, especially as it comes after a decade of near continuous declining numbers.

"Arresting and citing nearly half a million people a year for a substance that is objectively safer than alcohol is a travesty," said MPP communications director Morgan Fox. "Despite a steady shift in public opinion away from marijuana prohibition, and the growing number of states that are regulating marijuana like alcohol, marijuana consumers continue to be treated like criminals throughout the country. This is a shameful waste of resources and can create lifelong consequences for the people arrested."

Despite the lack of specific offense data, 2016 is unlikely to turn out markedly different from previous years when it comes to the mix of drug arrests. Past years typically had simple drug possession offenses accounting for 85-90 percent of all drug arrests and small-time marijuana possession arrests accounting for around 40 percent. 

That means of the more than 1.5 million drug arrests last year, probably 1.3 million or so of them were not drug kingpins, major dealers, gangbangers, or cartel operatives. Instead, they were people who got caught with small amounts of drugs for personal use. 

“Criminalizing drug use has devastated families across the U.S., particularly in communities of color, and for no good reason," said Maria McFarland Sánchez Moreno, executive director of the Drug Policy Alliance. "Far from helping people who are struggling with addiction, the threat of arrest often keeps them from accessing health services and increases the risk of overdose or other harms." 

Perpetuating the war on drugs leads not only to the criminalization of millions, but also perpetuates racially biased outcomes and heightens racial tensions in the U.S. Black people make up just 13 percent of the U.S. population and use drugs at similar rates to other ethnic groups, but they constitute 29 percent of all drug arrests and 35 percent of state drug war prisoners. 

And it has a huge negative impact on immigrants, fueling mass detentions and deportations. Non-citizens, including legal permanent residents—some of whom have been here for decades and have US citizen family members—face deportation for even possessing any drug (except first-time possession of less than 30 grams of marijuana). Between 2007 and 2012, more than a quarter million people were deported for drug offenses, including more than 100,000 deported for simple drug possession. 

In 2016, the Obama administration set the tone on drug policy and criminal justice matters, yet the number of arrests still went up. Now, with the "tough on crime" Trump administration, these disappointing numbers may be as good as it gets for the next few years. 

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More Arrests for Marijuana Than for Violent Crime Last Year

Mon, 09/25/2017 - 14:23
Click here for reuse options! The mass arrests are at odds with public opinion that supports ending the drug war.

Despite spreading marijuana legalization and a growing desire for new directions in drug policy, the war on drugs continues unabated. According to the FBI's latest Uniform Crime Report, released Monday, overall drug arrests actually increased last year to 1.57 million, a jump of 5.63 percent over 2015. The increase includes marijuana arrests, which jumped by more than 75,000 last year compared to 2015, an increase of 12 percent.

That comes out to three drug arrests every minute, day in and day out, throughout 2016. It's also more than three times the number of people arrested for violent crimes. Drug offenses are the single largest category of crimes for which people were arrested last year, more than burglaries, DUIs or any other criminal offense. 

Unlike previous years, this year's Uniform Crime Report did not immediately make available data on specific offenses, such as drug possession or drug sales, nor did it break arrests down by type of drug, but the Marijuana Policy Project obtained marijuana arrest data by contacting the FBI. It reported some 653,000 people arrested on marijuana charges last year, although the FBI did not provide data on how many were simple possession charges. 

While that figure marks a decline from historic highs a decade ago—pot arrests peaked at nearly 800,000 in 2007—the sharp jump in pot arrests last year demands explanation, especially as it comes after a decade of near continuous declining numbers.

"Arresting and citing nearly half a million people a year for a substance that is objectively safer than alcohol is a travesty," said MPP communications director Morgan Fox. "Despite a steady shift in public opinion away from marijuana prohibition, and the growing number of states that are regulating marijuana like alcohol, marijuana consumers continue to be treated like criminals throughout the country. This is a shameful waste of resources and can create lifelong consequences for the people arrested."

Despite the lack of specific offense data, 2016 is unlikely to turn out markedly different from previous years when it comes to the mix of drug arrests. Past years typically had simple drug possession offenses accounting for 85-90 percent of all drug arrests and small-time marijuana possession arrests accounting for around 40 percent. 

That means of the more than 1.5 million drug arrests last year, probably 1.3 million or so of them were not drug kingpins, major dealers, gangbangers, or cartel operatives. Instead, they were people who got caught with small amounts of drugs for personal use. 

“Criminalizing drug use has devastated families across the U.S., particularly in communities of color, and for no good reason," said Maria McFarland Sánchez Moreno, executive director of the Drug Policy Alliance. "Far from helping people who are struggling with addiction, the threat of arrest often keeps them from accessing health services and increases the risk of overdose or other harms." 

Perpetuating the war on drugs leads not only to the criminalization of millions, but also perpetuates racially biased outcomes and heightens racial tensions in the U.S. Black people make up just 13 percent of the U.S. population and use drugs at similar rates to other ethnic groups, but they constitute 29 percent of all drug arrests and 35 percent of state drug war prisoners. 

And it has a huge negative impact on immigrants, fueling mass detentions and deportations. Non-citizens, including legal permanent residents—some of whom have been here for decades and have US citizen family members—face deportation for even possessing any drug (except first-time possession of less than 30 grams of marijuana). Between 2007 and 2012, more than a quarter million people were deported for drug offenses, including more than 100,000 deported for simple drug possession. 

In 2016, the Obama administration set the tone on drug policy and criminal justice matters, yet the number of arrests still went up. Now, with the "tough on crime" Trump administration, these disappointing numbers may be as good as it gets for the next few years. 

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There Are Too Many Opioid Overdoses to Autopsy All the Bodies

Mon, 09/25/2017 - 12:08
Click here for reuse options! The massive increase in drug deaths has overburdened an industry.

In the rural and suburban communities where the opioid epidemic has hit hardest, so many people are dying of overdoses that medical examiners are unable to autopsy all the bodies. That means critical information—including accurate tallies of drug deaths that are used to inform policy—may be overlooked.

According to Vice News, an estimated 70 medical examiners offices around the country have accreditation from the National Association of Medical Examiners. NAME requires that no single medical examiner perform more than 250 autopsies a year, to minimize potential errors and ensure a standard of quality is met.

“If you go over that line, you’re more likely to make mistakes, take inappropriate shortcuts, etc.,” NAME president Brian Peterson explained to Vice. “If you’re under that line, you’re more likely to do a thorough job.”

The problem is, the opioid crisis has produced a massive increase in the number of bodies that indicate drug abuse as a possible cause of death. While full-body autopsies were once the standard way to establish proof of an overdose death, medical examiners’ offices are instead sending off samples for toxicology screenings. The practice keeps the number of autopsies down so the examiner's accreditation isn’t threatened. But it also means that once an overdose is ruled out, there’s no way to examine the body to establish the cause of death. The wait for a toxicology report to be completed can be as long as a month. By then, the body has generally been buried or cremated.

“The risk is to possibly miss an alternative cause of death,” Thomas Andrew, former chief medical examiner of New Hampshire, told the UK’s Daily Mail.

The way to solve the problem would be to increase the number of staffers, but that would require more resources and credentialed professionals to fill the jobs. Most ME offices don’t have budgets that would allow them to take on more hires.

“It's not like people are sending extra funds our direction,” Peterson, who in addition to his role at NAME is a medical examiner in Wisconsin, told the Daily Mail.

Connecticut’s Office of the Chief Medical Examiner experienced a threefold increase in the number of opioid-related deaths last year. The office performed so many autopsies its accreditation was removed this year. Chief medical examiner James Gill hardly expects to get the money his office would need to hire staff to meet demand. In the past, the state legislature hasn’t “been willing to fund us to the level we need,” Gill told Vice.

“It has strained our resources, our finances,” Andrew told the Daily Mail. “We can't use all of our resources to just do drug deaths. Where would the traffic crashes fit in? Where would the suicides fit in?”

Another issue is that there just aren’t that many forensic pathologists in the field. Vice points out that “just 35 people graduated from U.S. and Canadian medical schools and became forensic pathology residents in the 2015-2016 school year, according to the Association of American Medical Colleges.” If budgets were adjusted, the task of filling those positions would still be difficult.

“We just don’t produce enough new medical examiners each year to serve the country,” Thomas Baker, a Minnesota-based medical examiner, told Vice.

Without the clarity that autopsies provide, there’s a chance record-keeping around opioid deaths could be off. One University of Virginia study suggests that various issues result in opioid deaths being undercounted by as much as 20 percent. As Vice warns, those miscounts mean “prosecutors can have a harder time proving cause of death in criminal cases, and states may miss crucial public health information, especially during a crisis of unprecedented proportion.” Already tight budgets are likely to remain that way if death tolls are underestimated.

Jeff Sessions has suggested the Department of Justice will relaunch the war on drugs, although by every measure, the lengthy campaign was an unmitigated failure. Don Winslow, author of The Cartel and The Force, recently offered a list of the drug war's consequences in a piece for Time.

After five decades of this war, drugs are cheaper, more plentiful and more potent than ever (as Mr. Sessions himself has conceded)...The so-called War on Drugs quadrupled our prison population (overwhelmingly and disproportionately composed of minorities), handed out life sentences to nonviolent offenders, militarized our police forces, promoted the disgusting concept of for-profit prisons, shredded the Bill of Rights and cost taxpayers upward of a trillion dollars.

A World Health Organization survey recently found that America leads the world in illicit drug use. The U.S. also jails more people than any other country, by percentage and raw numbers.

Instead of the relaunching the war on drugs, the U.S. would do well to look at other countries with more successful responses to drug problems. In 2001, Portugal changed its laws to be less punitive for users caught with small amounts of drugs, and also instituted an aggressive public health campaign to address issues around addiction and drug abuse. Decriminalization has helped drive down overdose rates in the country drastically. New York Times columnist Nicholas Kristof notes that Portugal's “drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.” In the U.S., which had 64,000 drug overdose deaths in 2016, an increase of just over 20 percent from the year prior, the number of deaths is expected to be even higher this year.

“Most of us went [to] and are in this field because we can handle [it] emotionally. But what’s changed is, it’s just non-stop,” Kent Harshbarger, a forensic pathologist in Ohio, told Vice. “It’s like drinking from a firehose. It’s just coming too fast.”

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There Are Too Many Opioid Overdoses to Autopsy All the Bodies

Mon, 09/25/2017 - 12:08
Click here for reuse options! The massive increase in drug deaths has overburdened an industry.

In the rural and suburban communities where the opioid epidemic has hit hardest, so many people are dying of overdoses that medical examiners are unable to autopsy all the bodies. That means critical information—including accurate tallies of drug deaths that are used to inform policy—may be overlooked.

According to Vice News, an estimated 70 medical examiners offices around the country have accreditation from the National Association of Medical Examiners. NAME requires that no single medical examiner perform more than 250 autopsies a year, to minimize potential errors and ensure a standard of quality is met.

“If you go over that line, you’re more likely to make mistakes, take inappropriate shortcuts, etc.,” NAME president Brian Peterson explained to Vice. “If you’re under that line, you’re more likely to do a thorough job.”

The problem is, the opioid crisis has produced a massive increase in the number of bodies that indicate drug abuse as a possible cause of death. While full-body autopsies were once the standard way to establish proof of an overdose death, medical examiners’ offices are instead sending off samples for toxicology screenings. The practice keeps the number of autopsies down so the examiner's accreditation isn’t threatened. But it also means that once an overdose is ruled out, there’s no way to examine the body to establish the cause of death. The wait for a toxicology report to be completed can be as long as a month. By then, the body has generally been buried or cremated.

“The risk is to possibly miss an alternative cause of death,” Thomas Andrew, former chief medical examiner of New Hampshire, told the UK’s Daily Mail.

The way to solve the problem would be to increase the number of staffers, but that would require more resources and credentialed professionals to fill the jobs. Most ME offices don’t have budgets that would allow them to take on more hires.

“It's not like people are sending extra funds our direction,” Peterson, who in addition to his role at NAME is a medical examiner in Wisconsin, told the Daily Mail.

Connecticut’s Office of the Chief Medical Examiner experienced a threefold increase in the number of opioid-related deaths last year. The office performed so many autopsies its accreditation was removed this year. Chief medical examiner James Gill hardly expects to get the money his office would need to hire staff to meet demand. In the past, the state legislature hasn’t “been willing to fund us to the level we need,” Gill told Vice.

“It has strained our resources, our finances,” Andrew told the Daily Mail. “We can't use all of our resources to just do drug deaths. Where would the traffic crashes fit in? Where would the suicides fit in?”

Another issue is that there just aren’t that many forensic pathologists in the field. Vice points out that “just 35 people graduated from U.S. and Canadian medical schools and became forensic pathology residents in the 2015-2016 school year, according to the Association of American Medical Colleges.” If budgets were adjusted, the task of filling those positions would still be difficult.

“We just don’t produce enough new medical examiners each year to serve the country,” Thomas Baker, a Minnesota-based medical examiner, told Vice.

Without the clarity that autopsies provide, there’s a chance record-keeping around opioid deaths could be off. One University of Virginia study suggests that various issues result in opioid deaths being undercounted by as much as 20 percent. As Vice warns, those miscounts mean “prosecutors can have a harder time proving cause of death in criminal cases, and states may miss crucial public health information, especially during a crisis of unprecedented proportion.” Already tight budgets are likely to remain that way if death tolls are underestimated.

Jeff Sessions has suggested the Department of Justice will relaunch the war on drugs, although by every measure, the lengthy campaign was an unmitigated failure. Don Winslow, author of The Cartel and The Force, recently offered a list of the drug war's consequences in a piece for Time.

After five decades of this war, drugs are cheaper, more plentiful and more potent than ever (as Mr. Sessions himself has conceded)...The so-called War on Drugs quadrupled our prison population (overwhelmingly and disproportionately composed of minorities), handed out life sentences to nonviolent offenders, militarized our police forces, promoted the disgusting concept of for-profit prisons, shredded the Bill of Rights and cost taxpayers upward of a trillion dollars.

A World Health Organization survey recently found that America leads the world in illicit drug use. The U.S. also jails more people than any other country, by percentage and raw numbers.

Instead of the relaunching the war on drugs, the U.S. would do well to look at other countries with more successful responses to drug problems. In 2001, Portugal changed its laws to be less punitive for users caught with small amounts of drugs, and also instituted an aggressive public health campaign to address issues around addiction and drug abuse. Decriminalization has helped drive down overdose rates in the country drastically. New York Times columnist Nicholas Kristof notes that Portugal's “drug mortality rate is the lowest in Western Europe — one-tenth the rate of Britain or Denmark — and about one-fiftieth the latest number for the U.S.” In the U.S., which had 64,000 drug overdose deaths in 2016, an increase of just over 20 percent from the year prior, the number of deaths is expected to be even higher this year.

“Most of us went [to] and are in this field because we can handle [it] emotionally. But what’s changed is, it’s just non-stop,” Kent Harshbarger, a forensic pathologist in Ohio, told Vice. “It’s like drinking from a firehose. It’s just coming too fast.”

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Marijuana Legalization Isn't Causing More Pot Use, But Vice Versa

Mon, 09/25/2017 - 11:53
Click here for reuse options! Changing attitudes toward pot are driving both legalization and use rates.

Marijuana legalization is not the cause of increased marijuana use nationwide, a new study finds. Instead, it's the other way around: Marijuana legalization reflects increased acceptance of marijuana.

In the study, published this month in the journal Addiction, researchers from the Public Health Institute's Alcohol Research Group examined 30 years' worth of data from National Alcohol Surveys, which also include questions on marijuana use, and compared that data to changes in state laws.

What they found is not that pot policy drives behavior, but vice versa.

"Medical and recreational marijuana policies did not have any significant association with increased marijuana use," the authors concluded. "Marijuana policy liberalization over the past 20 years has certainly been associated with increased marijuana use; however, policy changes appear to have occurred in response to changing attitudes within states and to have effects on attitudes and behaviors more generally in the U.S."

Increasing marijuana use is "primarily explained by period effects," or social factors that impact populations across age and generational groups, and not by policy changes, the authors insist.

"The steep rise in marijuana use in the United States since 2005 occurred across the population and is attributable to general period effects not specifically linked to the liberalization of marijuana policies in some states," the paper concluded.

Those effects could include declining disapproval of marijuana among the overall population caused by increasing familiarity with the plant, as well as a tendency in surveys from earlier years for respondents to understate their actual marijuana usage.

The notion that policy does not drive drug use levels is not new. Academic researchers Peter Cohen and Craig Reinarman reported similar findings back in 2004. But the implications of such research are important: If drug policy has little impact on drug use levels, why have punitive drug policies?

 

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Marijuana Legalization Isn't Causing More Pot Use, But Vice Versa

Mon, 09/25/2017 - 11:53
Click here for reuse options! Changing attitudes toward pot are driving both legalization and use rates.

Marijuana legalization is not the cause of increased marijuana use nationwide, a new study finds. Instead, it's the other way around: Marijuana legalization reflects increased acceptance of marijuana.

In the study, published this month in the journal Addiction, researchers from the Public Health Institute's Alcohol Research Group examined 30 years' worth of data from National Alcohol Surveys, which also include questions on marijuana use, and compared that data to changes in state laws.

What they found is not that pot policy drives behavior, but vice versa.

"Medical and recreational marijuana policies did not have any significant association with increased marijuana use," the authors concluded. "Marijuana policy liberalization over the past 20 years has certainly been associated with increased marijuana use; however, policy changes appear to have occurred in response to changing attitudes within states and to have effects on attitudes and behaviors more generally in the U.S."

Increasing marijuana use is "primarily explained by period effects," or social factors that impact populations across age and generational groups, and not by policy changes, the authors insist.

"The steep rise in marijuana use in the United States since 2005 occurred across the population and is attributable to general period effects not specifically linked to the liberalization of marijuana policies in some states," the paper concluded.

Those effects could include declining disapproval of marijuana among the overall population caused by increasing familiarity with the plant, as well as a tendency in surveys from earlier years for respondents to understate their actual marijuana usage.

The notion that policy does not drive drug use levels is not new. Academic researchers Peter Cohen and Craig Reinarman reported similar findings back in 2004. But the implications of such research are important: If drug policy has little impact on drug use levels, why have punitive drug policies?

 

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I Moved to Colorado for Much More Than Marijuana

Mon, 09/25/2017 - 10:35
After a health crisis, what I did was legal — but it still wasn’t acceptable to my hosts

This feature is part of Salon’s Young Americans initiative, showcasing emerging journalists reporting from America’s red states. Read more Young Americans stories.

I remember why I chose to move to Colorado. It was early 2016, I was 23 and I was going through a breakup with my toxic birth family back in Nebraska. I’d decided to cut contact for my own health. My friend, let’s call her Renee, loved the idea of me starting fresh with her family’s help and was aflutter with sparkling, idealized images about her parents adopting me and us being sisters. So when her parents, let’s call them Carol and Rob, asked me to live with them, I thought I’d gained a new family and a nest where I could heal. I could be near my best friend and live in one of the most vibrant cities in America: Denver.

Of course I moved. Besides, I’d always felt like my soul belonged in Colorado. I’d visited several times as a child and never stopped being in awe of the landscape. I fell in love with the powerful, protective aura of the mountains and how their shadows zigzagged across the horizon like nature’s skyscrapers. I loved the beauty of it, how the sun dipped behind the mountains and cast the whole valley in swaths of pink and gold and purple. And I loved Denver, a city buzzing with 2.5 million more people than in my hometown and each of those new people singing promises of bright new possibilities. I went to Colorado for healing, for change, for the mountains’ beauty, the hope of a new family and a new future.

  

I moved to Colorado for so much more than the marijuana.

But the marijuana was a perk. In 2012, I had been diagnosed with a rare nerve disorder. Surgery and cannabis were the only known treatments. I’d had the surgery to get it corrected, but some problems remained. My Nebraskan surgeon quietly suggested cannabis and told me to try it if I had the chance. Naturally, I was ecstatic to finally move to a place where getting marijuana treatment was legal and safe.

I assumed Carol and Rob would understand. They were the picture of parenthood to Renee, and magnanimously offered that same relationship to me by dubbing me their “fourth child.” They offered to take care of me and let me live with them free of charge until I could get my feet on the ground. They made me feel at home, like I’d finally been granted a foster family to love me and help me heal. I saw no reason to keep my cannabis use a secret.

One evening I asked Carol if I could use her back porch to smoke.

It was immediate: the sharp hitch of silence, her frozen expression. In a second of panic I realized I’d said too much.

“Sure,” she said stiffly. And that was all.

I see now that was the moment I became a stoner in her eyes, and absolutely nothing more.

Our relationship ended there. Carol began stonewalling me, sending her husband Rob to deliver messages. I’d catch her saying I’d moved to Colorado “for the marijuana,” and this reflected in her attitude toward me. I tried everything to appease her and earn my keep by doing housework. It didn’t work. One afternoon she finally admitted to disliking me, citing our “different values” about drug use. I was heartbroken. I felt like I'd lost my mother all over again. Renee’s vision of me becoming her adopted sister had all but shattered. On the eve of Thanksgiving 2016, I was given four hours to move out and find a place to live elsewhere. Rob, once again speaking for Carol, insisted that I’d smoked indoors the previous night. I hadn’t. Still, I slept in my car for the next three days.

Growing up, I’d been warned there was a cost to smoking marijuana. The cost, I was told, would be brain damage, not being successful, or becoming a thug. But now I realize the cost of marijuana can be a social one, a label that separates you from your family and your friends by branding you a stereotype. Last year, the stigma separated me from Renee’s family and robbed me of the relationship I’d wanted with them. Now, in 2017, it robs me of my peace of mind when I’m meeting a new person, applying for jobs or choosing a roommate. Now I’m constantly examining myself and monitoring what I say. I have to think closely about those around me: Will my new roommate accept how I smoke in the evenings to ease my pain, or will I have to move out? Will my employer be compassionate about my cannabis treatment, or will I be subjected to mandatory drug tests? I live every day knowing that my choice of treatment may cost me my next job, my next friendship or even my next family member.

While I eventually recovered from being evicted last Thanksgiving and found shelter, I was left reeling with the bitter realization that prejudice could again put me on the street. I was forced to accept that whether in Colorado or not, the stereotype that marijuana users are social deviants lives on. And the social cost of using cannabis can remain steep, even where it’s legal.

 

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I Moved to Colorado for Much More Than Marijuana

Mon, 09/25/2017 - 10:35
After a health crisis, what I did was legal — but it still wasn’t acceptable to my hosts

This feature is part of Salon’s Young Americans initiative, showcasing emerging journalists reporting from America’s red states. Read more Young Americans stories.

I remember why I chose to move to Colorado. It was early 2016, I was 23 and I was going through a breakup with my toxic birth family back in Nebraska. I’d decided to cut contact for my own health. My friend, let’s call her Renee, loved the idea of me starting fresh with her family’s help and was aflutter with sparkling, idealized images about her parents adopting me and us being sisters. So when her parents, let’s call them Carol and Rob, asked me to live with them, I thought I’d gained a new family and a nest where I could heal. I could be near my best friend and live in one of the most vibrant cities in America: Denver.

Of course I moved. Besides, I’d always felt like my soul belonged in Colorado. I’d visited several times as a child and never stopped being in awe of the landscape. I fell in love with the powerful, protective aura of the mountains and how their shadows zigzagged across the horizon like nature’s skyscrapers. I loved the beauty of it, how the sun dipped behind the mountains and cast the whole valley in swaths of pink and gold and purple. And I loved Denver, a city buzzing with 2.5 million more people than in my hometown and each of those new people singing promises of bright new possibilities. I went to Colorado for healing, for change, for the mountains’ beauty, the hope of a new family and a new future.

  

I moved to Colorado for so much more than the marijuana.

But the marijuana was a perk. In 2012, I had been diagnosed with a rare nerve disorder. Surgery and cannabis were the only known treatments. I’d had the surgery to get it corrected, but some problems remained. My Nebraskan surgeon quietly suggested cannabis and told me to try it if I had the chance. Naturally, I was ecstatic to finally move to a place where getting marijuana treatment was legal and safe.

I assumed Carol and Rob would understand. They were the picture of parenthood to Renee, and magnanimously offered that same relationship to me by dubbing me their “fourth child.” They offered to take care of me and let me live with them free of charge until I could get my feet on the ground. They made me feel at home, like I’d finally been granted a foster family to love me and help me heal. I saw no reason to keep my cannabis use a secret.

One evening I asked Carol if I could use her back porch to smoke.

It was immediate: the sharp hitch of silence, her frozen expression. In a second of panic I realized I’d said too much.

“Sure,” she said stiffly. And that was all.

I see now that was the moment I became a stoner in her eyes, and absolutely nothing more.

Our relationship ended there. Carol began stonewalling me, sending her husband Rob to deliver messages. I’d catch her saying I’d moved to Colorado “for the marijuana,” and this reflected in her attitude toward me. I tried everything to appease her and earn my keep by doing housework. It didn’t work. One afternoon she finally admitted to disliking me, citing our “different values” about drug use. I was heartbroken. I felt like I'd lost my mother all over again. Renee’s vision of me becoming her adopted sister had all but shattered. On the eve of Thanksgiving 2016, I was given four hours to move out and find a place to live elsewhere. Rob, once again speaking for Carol, insisted that I’d smoked indoors the previous night. I hadn’t. Still, I slept in my car for the next three days.

Growing up, I’d been warned there was a cost to smoking marijuana. The cost, I was told, would be brain damage, not being successful, or becoming a thug. But now I realize the cost of marijuana can be a social one, a label that separates you from your family and your friends by branding you a stereotype. Last year, the stigma separated me from Renee’s family and robbed me of the relationship I’d wanted with them. Now, in 2017, it robs me of my peace of mind when I’m meeting a new person, applying for jobs or choosing a roommate. Now I’m constantly examining myself and monitoring what I say. I have to think closely about those around me: Will my new roommate accept how I smoke in the evenings to ease my pain, or will I have to move out? Will my employer be compassionate about my cannabis treatment, or will I be subjected to mandatory drug tests? I live every day knowing that my choice of treatment may cost me my next job, my next friendship or even my next family member.

While I eventually recovered from being evicted last Thanksgiving and found shelter, I was left reeling with the bitter realization that prejudice could again put me on the street. I was forced to accept that whether in Colorado or not, the stereotype that marijuana users are social deviants lives on. And the social cost of using cannabis can remain steep, even where it’s legal.

 

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An Ethical Dilemma for Doctors: When Is It Okay to Prescribe Opioids?

Mon, 09/25/2017 - 10:09
Pressure is on to scale back the prescribing of opioids. How do we balance that with not harming pain patients?

America’s opioid crisis is getting worse. The role of prescription opioids has both the medical establishment and the government justifiably worried.

In response, the National Academies of Science, Engineering and Medicine released an official report on the crisis earlier this year. And, on September 21, the National Academy of Medicine released a special publication calling clinicians to help combat the crisis.

As a bioethicist working on the ethical and policy issues regarding prescription opioids, I am grateful to the National Academy of Medicine for inviting me to serve on this publication’s authorship team, and for taking seriously the ethical component of the prescription opioid crisis. The opioid epidemic is shot through with ethical challenges.

There are many discussions we could have, but I will here focus on just one of them: the issue of morally responsible prescribing. Should prescription opioids be used at all? And if so, how? The question is obviously important for clinicians, but the rest of us – patients – should understand what our doctors and nurses owe us regarding our care.

Two public health crises

One of the central challenges of the opioid epidemic is figuring out how to respond without harming pain patients.

If opioids prevent significant suffering from pain, then the solution to the prescription opioid problem cannot simply be to stop using them. To do so would be to trade one crisis (an opioid crisis) for another (a pain crisis).

The data suggest, however, that pain patients’ interests will not always run counter to the goal of curbing the opioid crisis. The evidence favoring opioid therapy for chronic, noncancer pain is very weak, and there’s some evidence that opioid therapy can actually increase one’s sensitivity to pain.

Opioid therapy also comes with significant costs – the risk of addiction and the potential for drowsiness, constipation, nausea and other side effects.

As a result, more of the medical community is realizing that opioids are simply not good medications for chronic, noncancer pain. Getting patients off long-term opioid therapy may well improve their lives.

Should we use opioids at all?

It would be nice if we could simply stop using opioids. But the situation is rather more complicated than that.

Even if opioid therapy shouldn’t be first-line (or even second-line) treatment for chronic pain, that doesn’t mean that it won’t work for anyone. Patients are individuals, not data points, and risks of opioid therapy – as well as the risks of not providing pain relief – are not the same for everyone.

This is important because debilitating chronic pain can lead to a life that seems not worth living, and sometimes even to suicide. In the face of life-destroying pain, if we run out of other options, it’s not clear that we should avoid using a third-line treatment in the hopes of saving a life.

Those who have been on high doses of opioids for years or decades pose another serious challenge. Many of these patients are concerned about the backlash against opioids. Some believe that the opioids are saving their lives. Others may be terrified of going into withdrawal if their medication is taken away.

If we move away from opioid therapy too abruptly, physicians may abandon these patients or force them to taper before they are ready. Tapering, under the best of circumstances, is a long, uncomfortable process. If it’s badly managed, it can be hell. The health care system created these patients, and we don’t get to turn our backs on them now.

Finally, opioids are important medications for acute, surgical and post-traumatic pain. Such pain can require long-term treatment when a series of surgeries stretches out for months, or when a traumatic injury requires a long, painful recovery. In these cases, opioids often make life manageable.

Although calls to limit opioid prescriptions generally don’t target these patients, we might reasonably worry about shifting attitudes. If medical culture becomes too opioid-phobic, who will prescribe for these patients?

Responsible prescribing

Fighting the epidemic with nuance will require constant vigilance. In the new National Academy of Medicine publication, we suggest a number of ways that clinicians can work toward responsible prescribing and management of opioids.

In short, clinicians must prescribe opioids only when appropriate, employing nonopioid pain management strategies when indicated. Evidence supports the use of acetaminophen and ibuprofen, as well as physical therapy, exercise, acupuncture, meditation and yoga.

Clinicians must also be willing to manage any prescriptions they do write over the long term. And, at every stage, prescribers should collaborate with others as needed to ensure that patients receive the necessary care.

Although clinicians shouldn’t be “anti-opioid,” they should be justifiably wary of prescribing for chronic, noncancer pain. And when a prescription is appropriate, the clinician should not write for more than is needed.

Patients should go into opioid therapy with a rich understanding of the risks and benefits. They should also have a plan of care, including an “exit strategy” for getting off the medication.

A role for nonclinicians?

The suggestions above may seem straightforward, and perhaps even obvious. So it’s important to point out that this work is time-consuming and sometimes – as in the case of high-risk patients – challenging. Counseling, advising and trying to avoid unnecessary opioid use is much more difficult than writing a quick prescription.

Although this difficult work is still the clinician’s responsibility, the rest of us can make it easier for them to do their job well. After all, no one likes to experience unnecessary pain. Our expectation of powerful pain relief is part of the cultural backdrop of the epidemic.

That expectation is going to have to change. Moderate acute pain from injury, dental procedures or whatever may have yielded a prescription for Percocet or Vicodin in the past. And when we are the ones in pain, we might still prefer that doctors hand out such medication like candy. But the opioid epidemic is teaching us that we don’t, in fact, want that to be clinicians’ standard practice. We shouldn’t demand exceptions for ourselves.

 

 Related Stories
Categories: News Feeds

An Ethical Dilemma for Doctors: When Is It Okay to Prescribe Opioids?

Mon, 09/25/2017 - 10:09
Pressure is on to scale back the prescribing of opioids. How do we balance that with not harming pain patients?

America’s opioid crisis is getting worse. The role of prescription opioids has both the medical establishment and the government justifiably worried.

In response, the National Academies of Science, Engineering and Medicine released an official report on the crisis earlier this year. And, on September 21, the National Academy of Medicine released a special publication calling clinicians to help combat the crisis.

As a bioethicist working on the ethical and policy issues regarding prescription opioids, I am grateful to the National Academy of Medicine for inviting me to serve on this publication’s authorship team, and for taking seriously the ethical component of the prescription opioid crisis. The opioid epidemic is shot through with ethical challenges.

There are many discussions we could have, but I will here focus on just one of them: the issue of morally responsible prescribing. Should prescription opioids be used at all? And if so, how? The question is obviously important for clinicians, but the rest of us – patients – should understand what our doctors and nurses owe us regarding our care.

Two public health crises

One of the central challenges of the opioid epidemic is figuring out how to respond without harming pain patients.

If opioids prevent significant suffering from pain, then the solution to the prescription opioid problem cannot simply be to stop using them. To do so would be to trade one crisis (an opioid crisis) for another (a pain crisis).

The data suggest, however, that pain patients’ interests will not always run counter to the goal of curbing the opioid crisis. The evidence favoring opioid therapy for chronic, noncancer pain is very weak, and there’s some evidence that opioid therapy can actually increase one’s sensitivity to pain.

Opioid therapy also comes with significant costs – the risk of addiction and the potential for drowsiness, constipation, nausea and other side effects.

As a result, more of the medical community is realizing that opioids are simply not good medications for chronic, noncancer pain. Getting patients off long-term opioid therapy may well improve their lives.

Should we use opioids at all?

It would be nice if we could simply stop using opioids. But the situation is rather more complicated than that.

Even if opioid therapy shouldn’t be first-line (or even second-line) treatment for chronic pain, that doesn’t mean that it won’t work for anyone. Patients are individuals, not data points, and risks of opioid therapy – as well as the risks of not providing pain relief – are not the same for everyone.

This is important because debilitating chronic pain can lead to a life that seems not worth living, and sometimes even to suicide. In the face of life-destroying pain, if we run out of other options, it’s not clear that we should avoid using a third-line treatment in the hopes of saving a life.

Those who have been on high doses of opioids for years or decades pose another serious challenge. Many of these patients are concerned about the backlash against opioids. Some believe that the opioids are saving their lives. Others may be terrified of going into withdrawal if their medication is taken away.

If we move away from opioid therapy too abruptly, physicians may abandon these patients or force them to taper before they are ready. Tapering, under the best of circumstances, is a long, uncomfortable process. If it’s badly managed, it can be hell. The health care system created these patients, and we don’t get to turn our backs on them now.

Finally, opioids are important medications for acute, surgical and post-traumatic pain. Such pain can require long-term treatment when a series of surgeries stretches out for months, or when a traumatic injury requires a long, painful recovery. In these cases, opioids often make life manageable.

Although calls to limit opioid prescriptions generally don’t target these patients, we might reasonably worry about shifting attitudes. If medical culture becomes too opioid-phobic, who will prescribe for these patients?

Responsible prescribing

Fighting the epidemic with nuance will require constant vigilance. In the new National Academy of Medicine publication, we suggest a number of ways that clinicians can work toward responsible prescribing and management of opioids.

In short, clinicians must prescribe opioids only when appropriate, employing nonopioid pain management strategies when indicated. Evidence supports the use of acetaminophen and ibuprofen, as well as physical therapy, exercise, acupuncture, meditation and yoga.

Clinicians must also be willing to manage any prescriptions they do write over the long term. And, at every stage, prescribers should collaborate with others as needed to ensure that patients receive the necessary care.

Although clinicians shouldn’t be “anti-opioid,” they should be justifiably wary of prescribing for chronic, noncancer pain. And when a prescription is appropriate, the clinician should not write for more than is needed.

Patients should go into opioid therapy with a rich understanding of the risks and benefits. They should also have a plan of care, including an “exit strategy” for getting off the medication.

A role for nonclinicians?

The suggestions above may seem straightforward, and perhaps even obvious. So it’s important to point out that this work is time-consuming and sometimes – as in the case of high-risk patients – challenging. Counseling, advising and trying to avoid unnecessary opioid use is much more difficult than writing a quick prescription.

Although this difficult work is still the clinician’s responsibility, the rest of us can make it easier for them to do their job well. After all, no one likes to experience unnecessary pain. Our expectation of powerful pain relief is part of the cultural backdrop of the epidemic.

That expectation is going to have to change. Moderate acute pain from injury, dental procedures or whatever may have yielded a prescription for Percocet or Vicodin in the past. And when we are the ones in pain, we might still prefer that doctors hand out such medication like candy. But the opioid epidemic is teaching us that we don’t, in fact, want that to be clinicians’ standard practice. We shouldn’t demand exceptions for ourselves.

 

 Related Stories
Categories: News Feeds

A Marijuana Drive-Through Could Be Coming to a Corner Near You

Sat, 09/23/2017 - 11:27
Click here for reuse options! If you live in Maine, that is.

Voters in Maine narrowly approved marijuana legalization last November, and since then, the state legislature has been busily trying to come up with rules and regulations for the legal weed market. Now, they are envisioning something of a rarity: allowing customers to buy their weed at drive-up windows.

Of the five states that currently allow legal adult marijuana sales—Alaska, Colorado, Nevada, Oregon, and Washington—only Oregon and Colorado allow for drive-through sales. California, where sales are set to begin January 1, had drive-through sales written into draft regulations, but those proposed regs have had to be pulled and rewritten to comply with a state law merging the recreational and medical markets. Still, drive-through sales may survive the regulatory process there. Massachusetts hasn't directly addressed the issue, leaving it up to its Cannabis Control Commission to figure out before the state begins sales next summer.

For a measure whose mantra was "treat marijuana like alcohol," allowing drive-through pot sales seems like a no-brainer.

“If Maine allows it for alcohol, we see no reason why it shouldn’t be allowed for marijuana, the safer substance, so long as Maine puts in place reasonable regulations to protect public safety and the consumer,” David Boyer, director of the Maine chapter of the Marijuana Policy Project told the Portland Press Herald. “The voters want it regulated and taxed like alcohol. The rules should be the same.”

But it's not a done deal yet. The legislature's Joint Select Committee on Marijuana Legalization Implementation is still considering the draft bill, and the coming week will be crucial. The bill gets a public hearing Tuesday and legislative debate is set for Wednesday and Thursday. If the committee approves it, it goes before the full legislature next month.

Drive-through sales is one of a subset of non-storefront sales possibilities facing legal pot regulators. Sales by delivery services and online sales are additional bones of contention. The proposed Maine legislation would allow both of those, too, but not all the other legal states do.

It is a sign of significant progress, or course, that the debate has shifted from how hard to punish pot smokers and dealers to how best to accommodate and regulate legal marijuana. But legal marijuana still has a ways to go before we can say it is treated like alcohol. 

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A Marijuana Drive-Through Could Be Coming to a Corner Near You

Sat, 09/23/2017 - 11:27
Click here for reuse options! If you live in Maine, that is.

Voters in Maine narrowly approved marijuana legalization last November, and since then, the state legislature has been busily trying to come up with rules and regulations for the legal weed market. Now, they are envisioning something of a rarity: allowing customers to buy their weed at drive-up windows.

Of the five states that currently allow legal adult marijuana sales—Alaska, Colorado, Nevada, Oregon, and Washington—only Oregon and Colorado allow for drive-through sales. California, where sales are set to begin January 1, had drive-through sales written into draft regulations, but those proposed regs have had to be pulled and rewritten to comply with a state law merging the recreational and medical markets. Still, drive-through sales may survive the regulatory process there. Massachusetts hasn't directly addressed the issue, leaving it up to its Cannabis Control Commission to figure out before the state begins sales next summer.

For a measure whose mantra was "treat marijuana like alcohol," allowing drive-through pot sales seems like a no-brainer.

“If Maine allows it for alcohol, we see no reason why it shouldn’t be allowed for marijuana, the safer substance, so long as Maine puts in place reasonable regulations to protect public safety and the consumer,” David Boyer, director of the Maine chapter of the Marijuana Policy Project told the Portland Press Herald. “The voters want it regulated and taxed like alcohol. The rules should be the same.”

But it's not a done deal yet. The legislature's Joint Select Committee on Marijuana Legalization Implementation is still considering the draft bill, and the coming week will be crucial. The bill gets a public hearing Tuesday and legislative debate is set for Wednesday and Thursday. If the committee approves it, it goes before the full legislature next month.

Drive-through sales is one of a subset of non-storefront sales possibilities facing legal pot regulators. Sales by delivery services and online sales are additional bones of contention. The proposed Maine legislation would allow both of those, too, but not all the other legal states do.

It is a sign of significant progress, or course, that the debate has shifted from how hard to punish pot smokers and dealers to how best to accommodate and regulate legal marijuana. But legal marijuana still has a ways to go before we can say it is treated like alcohol. 

Click here for reuse options!  Related Stories
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The 7 Worst States In The Union To Get Caught With Cannabis

Fri, 09/22/2017 - 09:52
Which “dry” states have the most severe penalties for getting caught with the herb?

Sure, it’s easy enough to find out which states aren’t cannabis legal, even for medical, but which of these “dry” states have the most severe penalties for getting caught with the herb? Here’s the breakdown:

1. South Dakotais the worst state to get caught even buzzed in. The tiniest bit of pot will land one in jail for a year and cost $2,000 in fines. Wait though, if you have hash or concentrates? Then you’re looking at closer to five years in prison and fines up to $10,000. And possession what? Even if you test positive for marijuana, you face the same penalties.

2. Louisiana is known for its strict rules regarding possession, but it also has some of the most severe consequences for growing the plant. ANY cultivation under 60 pounds, including ONE plant, will lead to five to 30 years in prison plus or instead a $50,000 fine.

3. Indiana is almost as over the top as Louisiana when it comes to crime and punishment. One joint carries a $1,000 fine and a year in prison. Imagine what an ounce might entail…

4. Idaho’s a tricky one, because possession of up to three ounces is considered a misdemeanor that carries a $1,000 fine and up to a year in prison. That only covers possession though. Paraphernalia has the same penalties and public intoxication will get you another six months in prison. Hmm, a misdemeanor huh?

5. Iowa is harsh when it comes to first time offenders. If it’s your first time getting caught with a joint or a little cannabis, it’s punishable with up to six months in jail and $1,000 fine. The ACLU calls Iowa’s policy one of the harshest in the country for first timers.

6. Georgia has lax laws on small amounts, but do not get caught with over two ounces. Two ounces is the sweet spot for law enforcement and will earn you a prison term of up to ten years.

7. Arizona legalized medical marijuana, but if you don’t have a prescription, watch out. Even the smallest amount of pot, any amount at all, is a felony and one could face anywhere from four months to two years in jail for a joint.

Happy road tripping and/or simply living to all our friends out there, just keep in mind when to carry and when to lay low… Your freedom will thank you.

 

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Categories: News Feeds

The 7 Worst States In The Union To Get Caught With Cannabis

Fri, 09/22/2017 - 09:52
Which “dry” states have the most severe penalties for getting caught with the herb?

Sure, it’s easy enough to find out which states aren’t cannabis legal, even for medical, but which of these “dry” states have the most severe penalties for getting caught with the herb? Here’s the breakdown:

1. South Dakotais the worst state to get caught even buzzed in. The tiniest bit of pot will land one in jail for a year and cost $2,000 in fines. Wait though, if you have hash or concentrates? Then you’re looking at closer to five years in prison and fines up to $10,000. And possession what? Even if you test positive for marijuana, you face the same penalties.

2. Louisiana is known for its strict rules regarding possession, but it also has some of the most severe consequences for growing the plant. ANY cultivation under 60 pounds, including ONE plant, will lead to five to 30 years in prison plus or instead a $50,000 fine.

3. Indiana is almost as over the top as Louisiana when it comes to crime and punishment. One joint carries a $1,000 fine and a year in prison. Imagine what an ounce might entail…

4. Idaho’s a tricky one, because possession of up to three ounces is considered a misdemeanor that carries a $1,000 fine and up to a year in prison. That only covers possession though. Paraphernalia has the same penalties and public intoxication will get you another six months in prison. Hmm, a misdemeanor huh?

5. Iowa is harsh when it comes to first time offenders. If it’s your first time getting caught with a joint or a little cannabis, it’s punishable with up to six months in jail and $1,000 fine. The ACLU calls Iowa’s policy one of the harshest in the country for first timers.

6. Georgia has lax laws on small amounts, but do not get caught with over two ounces. Two ounces is the sweet spot for law enforcement and will earn you a prison term of up to ten years.

7. Arizona legalized medical marijuana, but if you don’t have a prescription, watch out. Even the smallest amount of pot, any amount at all, is a felony and one could face anywhere from four months to two years in jail for a joint.

Happy road tripping and/or simply living to all our friends out there, just keep in mind when to carry and when to lay low… Your freedom will thank you.

 

 Related Stories
Categories: News Feeds